Return to Scenario ListShow Learning Points most relevant to Phase 1:

Hand injury

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Orthopaedics, Plastic Surgery, Ethics
Progress Test Topic(s)
A 19 year old NZ European male presents with a swollen, painful right hand after falling whilst intoxicated. There is swelling over the back of his hand and he has two small wounds over his 4th and 5th knuckles. He appears angry and gives little extra history.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy of the hand and wrist
   - Common patterns of injury in the hand
   - Physiology of fracture healing
   - Blood supply of the scaphoid and relevance to fracture healing (avascular necrosis)
Clinical and Communication Skills 
   - History of a hand trauma; be aware that the history may be unreliable in certain situations
   - REBELS structure to deal with communication challenges (the 'angry patient')
   - Perform debridement and suturing of superficial lacerations
   - Perform assessment of scaphoid fracture and treatment/follow-up of scaphoid fractures
   - Assessment of other potential distant sites of trauma (head, neck, torso, other extremities)
   - Interpretation of plain x-rays of the hands and fingers
   - Management of open fractures
   - Management of human bite wounds
Personal and Professional Skills 
   - Non-judgemental attitude to history of events
   - Develop trust to facilitate sharing of history/events
   - Ability to engage in clinical interactions in a way that respects and upholds patient rights
   - Ethics of information sharing/confidentiality with third parties
   - Understanding your role in relation to patients involved with police
   - Hand-dominance and effect on employment/recreation
Hauora Māori 
   - Avoid stereotypes/prejudice for young Māori (e.g. that Māori are violent, drug takers, likely to be in fights), and explore specific risk factors for each individual
   - Explore access to care/follow-up issues for management of hand injury (e.g. deprivation, employment issues/time off work)
Population Health 
   - Epidemiology of alcohol-related harm
   - Strategies for preventing harm from alcohol
   - Burden of alcohol abuse on Emergency Department services in New Zealand
   - Relationship of alcohol abuse and interpersonal violence
   - Role of the brief intervention in alcohol abuse
   - Immunisation status of adults in New Zealand
Conditions to be considered relating to this scenario
metacarpal fracture, other hand/wrist fractures including scaphoid and Bennett's fracture, tendon laceration, finger dislocations
Less common but 'important not to miss'
compartment syndrome, tendon sheath infection, animal bites, open fractures, nerve/vascular laceration, tetanus
traumatic amputations, lunate dislocation, de-gloving and crush injuries, tendon rupture (e.g. rheumatoid arthritis or post-fracture)